Abstract
To determine the discrete nature of social interactions occurring in nurse practitioner consultations and investigate the relationship between consultation social interaction styles (biomedical and patient-centred) and the outcomes of patient satisfaction, patient enablement, and consultation time lengths. A case study-based observational interaction analysis of verbal social interactions, arising from 30 primary health care nurse practitioner consultations, linked with questionnaire measures of patient satisfaction and enablement. A significant majority of observed social interactions used patient-centred communication styles (P=0.005), with neither nurse practitioners nor patients or carers being significantly more verbally dominant. Nurse practitioners guided the sequence of consultation interaction sequences, but patients actively participated through interactions such as asking questions. Usage of either patient-centred or biomedical interaction styles were not significantly associated with increased levels of patient satisfaction or patient enablement. The median consultation time length of 10.1 min (quartiles 8.2, 13.7) was not significantly extended by high levels of patient-centred interactions being used in the observed consultations. High usage levels of patient-centred interaction styles are not necessarily contingent upon having longer consultation times available, and clinicians can encourage patients to use participatory interactions, whilst still then retaining overall guidance of the phased sequences of consultations, and not concurrently extending consultation time lengths. This study adds to the body of nurse practitioner consultation communication research by providing a more detailed understanding of the nature of social interactions occurring in nurse practitioner consultations, linked to the outcomes of patient satisfaction and enablement.
Highlights
Rates of patient question-asking in consultations, which have been noted as a key feature of patient-centred communication, have not been fully evaluated in nurse practitioner consultations, though they have been previously in medical consultations (Roter, 1984; Street et al, 2005; Peräkylä et al, 2007)
The aims of this study were to determine the discrete nature of social interactions occurring in nurse practitioner consultations and to investigate the relationship between consultation social interaction styles and the outcomes of patient satisfaction, patient enablement, and consultation time lengths
Patient satisfaction and patient enablement were measured in the case study using two previously tested and validated questionnaires: the Nurse Practitioner Satisfaction Survey measuring both communication satisfaction and general satisfaction (Agosta, 2009); and the Patient Enablement Instrument (PEI) (Howie et al, 1997; 1999)
Summary
In many countries across the world nurse practitioners are increasingly being used as part of workforce developments to take on roles, such as consulting with patients and subsequently making full diagnostic and treatment decisions more traditionally associated with medical doctors (Department of Health, 2010; Health Education England, 2017; Hill, 2017), but comparatively little is known about how nurse practitioners and patients communicate with each other during their consultations (Charlton et al, 2008; Barratt, 2016).Examples of available studies of the communication processes of nurse practitioner consultations iteratively show that nurse practitioners mostly emphasise socio-emotional styles of communication in their consultations in preference to using solely biomedical styles of communication (Brykczynski, 1989; Johnson, 1993; Kleiman 2004; Barratt, 2016; Defibaugh, 2014a; 2014b). Rates of patient question-asking in consultations, which have been noted as a key feature of patient-centred communication, have not been fully evaluated in nurse practitioner consultations, though they have been previously in medical consultations (Roter, 1984; Street et al, 2005; Peräkylä et al, 2007).
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